Authors Note: This article was originally written in 2018, but never sought publication. In light of the recent events unfolding around COVID-19, this article serves as “food for thought” why pandemic diseases are such a vulnerability and why public safety leaders should be taking any epidemiological threat seriously. While reading, consider the lack of free travel, EMS services and even the concept of emergency rooms in 1918. That is why the current threat climate is, shall I say, “novel” to us as emergency responders. There are lessons to be learned.
Nearly one century ago, beginning in 1918, a disaster which the modern world had not experienced yet began to systematically kill an estimated 50-to-100-million people worldwide over the course of 24 months. Within the United States alone, low end estimates of 670,000 citizens were killed by the virus.1 To put that into modern perspective, this disaster killed the equivalent number of U.S. citizens as over two hundred 9/11 attacks. Today, the two most frightening aspects of this disaster are that the threat is still here and will happen again, and you cannot see it. This threat is pandemic influenza.
While the exact origins of the 1918 to 1920 influenza pandemic are not agreed upon, what is for certain is that this strain of flu, colloquially referred to as The Spanish Flu, is exclusively a human pathogen known to scientists and physicians as the H1N1 viral strain.2
The prevailing theory of how this virus was spread globally lies in the parallel history of world events. The first reported cases within the United States, based on records from the time, point toward an origin located in central Kansas at a U.S. Army training facility named Camp Funston. In March 1918. Camp Funston was an initial training center for U.S. Army troops who were deploying to Europe for World War I. After graduation, troops from Camp Funston were sent to their units across the United States before being dispatched to Europe.
Within weeks of the first reported cases of what was considered seasonal influenza at Camp Funston, 24 of the 36 large military bases began reporting outbreaks of influenza. By September of 1918 at Camp Devens, which was situated just outside of Boston, the base hospital was overwhelmed with influenza. In a single day that month, 1,543 soldiers reported being sick with influenza.3
What was not known at the time in the United States was that infected soldiers had already deployed and had their boots on the ground in France. Many departed their ships and onto European soil complaining of what the soldiers themselves had termed “the three day fever” and suggested that it was due to the conditions in the merchant marine and military ships in which they were transported. From here, any and all ability to contain the virus was lost.
The numbers of deaths were staggering. No population within the United States was left unscathed. Native American tribes were hit especially hard and some Alaskan Inuit tribes became extinct. During this time period of the H1N1 pandemic, global life expectancy declined by 12 years.4
Today, the Department of Homeland Security is tasked with preparing the nation for the next pandemic event. Almost everyone in the scientific community and those tasked with defending the homeland agree that the next pandemic flu or other viral outbreak is not a matter of if, but rather a matter of when. Comparing a snapshot of the nation today to its own image in 1918, experts note that the travel and spread of diseases, whether naturally occurring or weaponized for criminal intent, is much more complex and rapid today than a century ago.
The Spanish Flu spread across the globe via steamship and across the routes of conflict and war. Today, a small outbreak of a disease in nearly any part of the world can easily be transmitted to multiple points of the globe within hours due to air travel.1 Most recently in 2014, the deadly virus Ebola easily escaped the small African nations of Guinea and Sierra Leone despite the presence of the United Nations and other non-governmental organizations attempting to contain the virus. With a 50% mortality rate for those who contract the disease, it is the world’s most deadly virus.
In the 2014 outbreak, there were 36 cases reported outside of the African continent. Eleven of those cases were here in the United States and it was the first time Ebola was seen in North America.5 A 2018 poll showed that frontline responders, namely EMS and fire, were unprepared for an outbreak of Ebola, and therefore perhaps even a pandemic of any nature to include influenza. The poll, ran during EMS Week of 2018, showed 80% of first responders had done no additional training in pandemic response since the 2014 initial Ebola threat in the United States. Another 20% had no knowledge that Ebola was still a threat.6
On a national scale, the Department of Homeland Security has taken dramatic efforts to combat influenza and other pandemic diseases because of the seriousness in which pandemics pose to the homeland based on the lessons of 1918’s Spanish Influenza. The Department of Homeland Security’s response leverages the capacity of the agencies under their command to monitor and prevent further outbreak. This includes, diverting flights inbound to the United States and its territories, additional screening by TSA agents at airports, using the U.S. Coast Guard to monitor vessels from effected nations, initiating FEMA’s response centers, and securing borders with various assets at its disposal. Further, during a pandemic disease outbreak, the DHS combines efforts with the Center for Disease Control and the National Heal Service.7
In 2005, then DHS Secretary Michael Chertoff wrote: “A severe pandemic influenza presents a tremendous challenge as it may affect the lives of millions of Americans, cause significant numbers of illnesses and fatalities, and substantially disrupt our economic and social stability. It is imperative for government officials and business leaders to work together now to develop effective pandemic related business continuity plans and to implement successful preparedness and protective strategies.”8
While homeland security is filled with many disasters and the lessons learned paid for with lives of the innocent, no other event in our nations or the modern world’s history has had such a dramatic impact as the 1918 Spanish Influenza Pandemic. The H1N1 virus and its variants are here still to this day. The Spanish Flu was never eradicated. Couple that fact with this staggering statistic: the average American is more than five times more likely to die from a human-extinction event than in a car crash,9 yet we still wear our seatbelts.
1. Morens, David, Anthony S. Fauci; The 1918 Influenza Pandemic: Insights for the 21st Century, The Journal of Infectious Diseases, Volume 195, Issue 7, 1 April 2007, Pages 1018—1028, https://doi.org/10.1086/511989.
2. Crosby, A. W. (1976). Epidemic and peace, 1918. Westport, CT: Greenwood P. Retrieved November 26, 2018. 978-0-8371-8376-3.
3. Barry, J. M. (2017, November). How the Horrific 1918 Flu Spread Across America. Smithsonian. www.smithsonianmag.com/history/journal-plague-year-180965222/.
4. Berkeley; Life Expectancy in the US, 1900-98. (2003). Retrieved November 27, 2018, from http://www.demog.berkeley.edu/~andrew/1918/figure2.html.
5. CDC; Ebola (Ebola Virus Disease). (2017). https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html.
6. Beers, T. P. (2018, May 21). 2018 EMS Week Twitter Poll[Informal Poll on Social Media]. https://twitter.com/Fire_Leadership/status/998647247998013442.
7. What DHS does during Pandemics. (2016, May 31). Retrieved from https://www.dhs.gov/what-dhs-does-during-pandemics#.
8. Chertoff, Michael; Secretary, Department of Homeland Security. (2006). Retrieved November 26, 2018, https://www.dhs.gov/sites/default/files/publications/cikrpandemicinfluenzaguide.pdf.
9. Meyer, R. (2016, May 11). You’re More Likely to Die in a Human Extinction Event Than a Car Crash. Retrieved from https://www.theatlantic.com/technology/archive/2016/04/a-human-extinction-isnt-that-unlikely/480444/.